Sunday, January 9, 2022

Emblemhealth – the Big Winner in the Medicare Advantage Scam.

Please refer to previous postings on the City’s attack on its retirees’ Medicare benefits and the bogus Medicare Advantage Plus (MAP) plan.


Since the mid 1940’s GHI and HIP have been the main health insurance providers for NYC workers and retirees. In 2005 these two firms announced their merger to form Emblemhealth. Interestingly, the City fought the merger in federal court on antitrust grounds claiming it would increase its health insurance costs. The City lost the case.

Cash Flow

In FY-2021, the City paid approximately $3.372B for city workers health insurance and $1.6B for city retirees’ health insurance. This is approximately 5% of the City’s total budget. Almost all of the $5.0B was paid to Emblemhealth via GHI and HIP. The City is Emblemhealth’s primary client. Because of the amounts of money involved and the time length of the relationship, there is a serious potential for corruption between the City and Emblemhealth. And city unions!

This is a huge business for Emblemhealth. Can you just imagine if Aetna started to tap into this gold mine?


The NYC Office of Labor Relations (OLR) is the statutory administrator of health insurance benefits (Section 12-126.d of NYC Admin Code). From my long experience in administering NYC pension benefits, it is my opinion that OLR is quite effective in negotiating labor contracts but incapable of managing large scale data intensive employee benefit operations. OLR contracts out all this type of work with minimal "oversight".

The following is a recent notice from AM Best, a firm that monitors the credit worthiness of insurance companies.

April 28, 2021 09:32 AM Eastern Daylight Time OLDWICK, N.J.--(BUSINESS WIRE)--AM Best has removed from under review with negative implications and affirmed the Financial Strength Rating of C+ (Marginal) and the Long-Term Issuer Credit Ratings of “b-” of Health Insurance Plan of Greater New York (HIP), EmblemHealth Insurance Company, EmblemHealth Plan, Inc. (EHPI) and ConnectiCare, Inc. (ConnectiCare) (Farmington, CT). All companies are subsidiaries of EmblemHealth, Inc. and domiciled in New York, NY, unless otherwise specified. The outlook assigned to these Credit Ratings (ratings) is negative.

The removal of the ratings from under review follows the completion of AM Best’s assessment of the consolidated financials of the group through year-end 2020 and assessment of the capital restoration plan.

The ratings reflect EmblemHealth Group’s balance sheet strength, which AM Best assesses as very weak, as well as its marginal operating performance, neutral business profile and marginal enterprise risk management….

Wasn’t this the exact time that the City/Municipal Labor Council (MLC) were negotiating with Emblemhealth for the MAP contract?

New Deductibles and Copay for GHI Senior Care

The week before Christmas I received a letter as a NYC retiree from Emblemhealth. It was dated December 17, 2021 and signed by a George Babitsch, a senior vice president.

The letter was a notice of changes to my GHI Senior Care Medigap insurance plan. The changes were to be effective January 1, 2022. These changes have an immediate impact of retirees over age 65 and future impact on all current city retirees and workers.

Babitsch claims the changes were based on negotiations between the NYC Office of Labor Relations (OLR) and city unions via the Municipal Labor Committee (MLC). City unions have no collective bargaining authority over current retirees, only current workers. If the unions want to negotiate reductions in the health insurance benefits of current workers, they are free to negotiate those benefits.

There is, however, a statutory guarantee that the City pay the entire cost of health insurance coverage for workers, retirees and there beneficiaries limited only by the cost of the HIP-HMO benefit.

There is also an added statutory protection for retirees who retired from the NYC Department of Education or the old Board of Ed. See the quote below from the legislative history of this law.

The law provides that school districts may reduce neither the level of health insurance coverage nor their contribution toward its cost for retirees, unless the reduction applies equally to active employees. This protects retirees by in effect making them part of the collective bargaining process.

The changes are

  • 1) an imposition of an added $50 annual deductible on top of the regular Medicare Part B deductible of $233 for 2022, and
  • 2) $15 copay for every medical service.

There are 157,381 NYC retirees covered by Senior Care (see below). If these changes go into effect, they will cost retirees $31.4M per year which in turn will increase Emblemhealth's annual profit. How does the City escape paying for these changes?

Litigation and the MAP Plan

Partly because of these changes, the City is in a legal fight with the retirees over the attacks on their benefits. I’m quite sure that the City did not expect the retirees to fight back.

Along with the Senior Care changes, the City and Emblemhealth are also trying to force these 157,381 retirees into the Medicare Advantage Plus (MAP) plan.

If that effort is successful, the City will no longer have to pay for the retirees’ Senior Care coverage ($194/month) and Emblemhealth stands to increase its regular annual profit of $36.6M for Senior Care plan into an annual profit of $207.7M for the MAP plan.

The retirees will lose their traditional Medicare benefit. Also MAP, as Medicare Advantage plan, will force retirees to buy their Part D drug coverage from the MAP plan.

Speaking of Part D, in New York State, you can get an excellent Part D plan from Aetna for $77.20 per month as opposed to the $125 that Emblemhealth is charging in the MAP plan and the Senior Care plan(2022). It was $150.30 in 2021. You may be starting to see a pattern in the relationship between the City and Emblemhealth.

Opting Out of the MAP Plan

If the retirees opt out of the MAP plan, the retirees will have to pay $191 per month for Senior Care plan and double that if their spouses are covered. This is in addition to the $125 per month charge for the retiree and the spouse each for Part D coverage. If the retiree chooses to buy Part D on the open market, they will lose any subsidy that they receive from their welfare funds.

Now that retirees are paying for Medigap insurance, shouldn't they be free to pick the plan that thet want? Well not really. If the retiree wants to switch from the GHI Senior Care (Medigap Plan A) and buy a less expensive and more effective Medigap Plan A in NYS(chart), the City is threatening to block the refunds for Part B premiums that retirees pay Medicare each month. The refunds, like like health insurance covergae, are mandated by Section 12-126 of the NYC Admin Code. Why would the City make this threat? Is the City trying to protect Emblemhealth's market share?

I can see if the City was paying for the Medigap insurance that it would want to control who the vendor was. But once the retiree is paying the cost for the insurance, why would the City care who the company was?

Of course the City is doing the same thing with the MAP plan. If the retiree dares to go to another Medicare Advantage plan, he/she will lose their Part B premium refund.

Where the Money Comes From

In a Medicare Advantage plan, CMS, the federal Medicare administrator, will give Emblemhealth roughly $1,100 a month per captured retiree and CMS only requires Emblemhealth to pay out 85% of that amount in health benefits. You can easily do the arithmatic. With a 10% profit margin you generate $207M per year. That does not include whatever it can pull in from its charges for the Part D coverage. I am beginning to become very suspicious of this deal.

As stated before, Emblemhealth is now offering the City a new Medicare Advantage plan that will cost the City nothing. Only for the first year of the five-year contract is there a token monthly premium of $7.5 per retiree. I suspect that the lawyers inserted this trivial amount to ensure that the contract is valid.

HIP-HMO for Medicare Eligible Retirees

As of June 30,2021, there were 22,404 Medicare eligible city retirees covered by HIP-HMO. This is a Medicare Advantage (MA) plan that has been in place for years. It is a voluntary plan as opposed to the MAP plan.

It is not clear what is going on with the future coverage for retirees in the HIP-HMO (MA) plan.

It is also not clear what is going on generally with the charges for Medicare retirees with families who are not Medicare eligible.

Comparing the number of participants in the Senior Care and the HIP-HMO plans, you can easily see that Senior Care is the dominant plan for Medicare eligible retirees and that has been true for decades.

You might wonder what has been going on with HIP-HMO Medicare Advantage plan for all these years? Why was there a cost for the HIP-HMO (MA) plan when the new MAP plan is now free or precisely, why did the HIP-HMO (MA) cost the City $48.8M per year for 22,404 retirees and the MAP plan for 157,381 retirees will cost the City nothing?

Stats from the Actuary’s 2021 OPEB Report

As per the OPEB report for 2021 from the NYCERS’s actuary the following is the major breakdown NYC retirees and health insurance coverage. A small portion of retirees (10,478) chose other plans that have added charges,

  • Medicare eligible retiree:
    • a. 157,381 retirees covered by GHI Senior Care (Medigap – Plan A)
      • i. Monthly cost per retiree and spouse: $194.14 each
      • ii. Monthly cost per retiree with younger family: $2,035.61
    • b. 22,404 retirees covered by HIP-HMO (Medicare Advantage)
      • i. Monthly cost per retiree and spouse: $181.58 each
      • ii. Monthly cost per retiree with younger family: $1,901.23
  • Non-Medicare eligible retiree:
    • a. 62,779 retirees covered by GHI-CBP/EBCBS
      • i. Monthly cost per single retiree: $775.66
      • ii. Monthly cost per retiree/family: $2,035.61
    • b. 9,169 retirees covered by HIP-HMO
      • i. Monthly cost per single retiree: $776.01
      • ii. Monthly cost per retiree/family: $1.901.23

That adds up to the following annual revenue paid by the City to Emblemhealth for just retirees:

  • a) Medicare eligible retirees (assuming no younger families) of
    • a. $48.8M for HIP-HMO
      • ($181.58 * 12 * 22,4040) and
    • b. $366.6M for Senior Care
      • ($194.14 * 12 * 157,381)
  • b) Non-Medicare eligible retirees (assuming 50% with families)
    • a. $144.6M for HIP-HMO
      • ($776.01/$1,901.23 * 12 * 9,169)
    • b. $1,040.3M for GHI-CBP/EBCBC
      • ($775.66/$2,035.61 * 12 * 62,779)

All these plans are run by Emblemhealth.

Monday, December 13, 2021

Medicare Advantage: Attack on Medicare

Because of the City's attempt to cut and run on health insurance benefits for NYC retirees, I've started to do research on Medicare and Medicare Advantage (MA) programs.

By statute New York City is required to pay the entire cost for the health insurance of its workers, retirees and their dependents with an upper limit equal to the cost of HIP-HMO plans. Prior to reaching age 65 the basic cost of that insurance is $775 per month for each worker or retiree. If the worker or retiree has a family, the cost is $2,035 per month. These amounts are current as of FY-2021. Interestingly, city workers and retirees have to pay for their own drug coverage.

When the retiree reaches age 65, the retiree becomes eligible for Medicare and is required to enroll in Medicare. The City then only has to pay the cost of Medicare Supplemental (Medigap) insurance ($194.14 per month). Medigap insurance, GHI Senior Care, covers the 20% of costs that traditional Medicare does not pay. There are some other plans available at 65. You can more info in the Actuary's report

The City is also required by statue to refund to the retiree the Medicare Part B monthly premiums ($146.97 as of 2021) that the retiree must pay for Part B Medicare coverage. If the Medicare retiree still has younger family members that are entitled to paid health insurance, I strongly suspect that the City doesn't need to pay the $194.14 per month because the City is still paying the $2,035 per month family premium to Emblemhealth GHI.

NYC Eligible Retirees - Traditional Medicare With Secondary Medigap insurance

Medicare is a federal benefit that workers and retirees pay taxes for. Retirees have paid into the Medicare system for their entire careers with all employers that they worked for whether or not they it was the City. The City has no right to this benefit.

The current health insurance arrangement for NYC retirees requires the retirees to register with Medicare when they turn 65 and to notify OLR that they are now being covered by Medicare. Then based on the plans offered by OLR, the retiree picks which secondary insurance that they want. The vast majority of retirees pick GHI Senior Care. This is a Medicare Supplement insurance (Medigap) plan.

Medigap plans are run by private insurance companies and are required to conform to structures defined by Medicare. In New York State these plans are subject to oversight by the NYS Department of Financial Services. It appears that GHI Senior Care is a Type A Medigap plan based on its cost. OLR has never been very transparent about this whole process. Needless to stay it is the cheapest plan available. FYI: There are 10 Medigap plans defined by Medicare.

In spite of the limits of GHI Senior Care and the cost of drug coverage, city retirees after age 65 have excellent health covereage at a very reasonable cost.

The Medicare Advantage Invasion - Private Sector Insurance

From my reasech it is clear that for many years the health insurance industry has been attempting to infiltrate the successful government Medicare payment system. Medicare Advantage is the program that allows private insurance to accomplish this infiltration.

CMS is the federal government agency that administers Medicare and pays the bills for Medicare eligible retirees health costs. CMS pays the bills directly for traditional Medicare and funds the insurance companies when the retiree has elected a Medicare Advantage plan. The name Medicare Advantage is a marketing ploy. This is a private insurance plan.

This attack on Medicare is driven by greed and survival. The insurance companies very quickly realized that Medicare, passed in 1965, was going to over take their business model because of it effectiveness and the fact that they were being completely left out of the payment cycle of health costs for retirees.

The insurance companies knew that they had to get into the payment cycle between CMS and retirees so that they can get a cut of the action. We are talking about private companies getting a significant potion of the taxes paid by workers and retirees over their careers and into retirement for their health care.

Even with Medicare Advantage retirees most still pay Medicare Part B premiums out of their Social Security checks. They may also have to pay a premium to the MA insurance company even though some MA plans have no premiums.

In traditional Medicare, CMS pays 80% of a retiree's Medicare approved health costs. It spends only 2% of its expenses on administrative costs.

In a MA plan, the MA insurance company uses money that CMS allocates to the company to pay retireess' health care costs. That amount is based on the number and the health status of retirees enrolled in its plan. In the NY area, that amount is roughly $1,100 per month per eligible retiree. The company is allegedly required to pay out 85% of that amount to cover 100% of retiree's Medicare approved health costs. They can keep the rest to cover costs and profit.

Assuming a 10% profit margin, the new Emblemhealth/Blue Cross Medicare Advantage plan will clear $110 per month per captured retiree. That is $198M per year if the City can deliver 150,000 retirees. Not bad for an inferior product. You start to get very suspicious when there is this much money floating around.

Sounds like a win/win deal? The MA process is supposed to be better than the one run by CMS but you kind of know it isn't.

The MA system doesn't work as straight forwardly as the traditional Medicare plan run by CMS. Insurance companies must make a profit or they go out of business. So how do they make 80% cover 100% of costs. They inflate adjusted payments from CMS for each retiree by claiming that the retiree has significant health problems, they reduce and delay payments to doctors and hospitals, and they charge retirees for unapproved costs and copays. 

The key to this strategy is that the insurance company takes control of the decision process of what medical treatment retirees receive and what actual payments are made to doctors and hospital. This puts the retiree at the mercy of the insurance company. If you are healthy, this generally is not a problem. If, however, you have serious health issues which many retirees do, you will problems. Problems which will very often force you back into traditional Medicare and maybe without the option of an affordable Medigap insurance plan.

The Attack is Getting More Intense

As you can read in the following critique, private interests are increasing their attacks on Medicare. This stuff is frightening and I suspect is a residue of the Trump administration.

Another threat is involuntary auto enrollment into a MA plan. Without the forced enrollment the City's Medicare Advantage plan would get only a trivial number of voluntary enrollees and none if the City had not reneged on its commitment to pay for Medigap insurance.


The City and the leaders of major unions agreed to degrade retirees and workers Medicare benefits to funnel the savings into the unions' welfare funds. I suspect that when workers get a clear understanding of this betrayal, these leaders will be in for a reckoning.

Assuming a 10% profit and 150,000 captured retirees, Emblemhealth stands to increase its annual profit from $34.92M to $198.00M by shifting from Senior Care to the Medicare Advanatage plan.

Who do you think was pushing for this plan? Not the workers and retirees!

Thursday, December 2, 2021

NYS Medigap Rate Chart for 2022 and the NYC Medicare Advantage Scam

New York State and Medigap Insurance

If you click on the link below, you will see the all the Medicare Supplememt(Medigap) insurance plans available in New York State for 2022 along with their monthly premiums. These plans are avalilable on the open market to everyone covered by traditional Medicare. I have always found when you get to see everyting laid out in chart, it all comes into focus.

NYS Medigap Rate Chart for 2022

Medigap inurance is what the City currently provides for retired City workers who are eligible for and covered by Medicare. The City pays a $194 premium per month per retiree to EmblemHealt/GHI. If the retiree is married the City also pays another $194 per month for the spouse if he/she is also eligible for Medicare.

This Medigap insurance, GHI Senior Care, appears to be a Plan A type of Medigap insurance based on its cost. This is the lowest cost Medigap insurance that CMS, the federal Medicare administraror, allows to qualify as Medicare Supplemental insurance. Medigap insurance basically covers the 20% of medical costs that Medicare doesn't cover.

As compared to Plan A, Plan F is the best type of Medigap insurance that you can buy as you can see in the chart. You can bet your ass that the City wasn't going to provide a Plan F type Medigap insurance for its retirees. You can see all the premium rates for all the plans in the NYS chart. The NYS Department of Financial Services (DFS) oversees the Medigap insurance plans sold in the state. DFS does not have authority over Medicare Advantage plans.

Critique of Medicare Advantage Problems

This is a clear critique of the Medicare Advantage business model and who gets the short end of the stick. Read this link, Medicare Advantage critique

Sunday, November 28, 2021

Attack on the NYC City Council and the Health Benefits of NYC Workers and Retirees

The battle over health insurance for NYC Medicare eligible retirees is being fought over 126.b.(1) of the NYC Admin Code as well as workers’ contractual rights. This fight, however, effects all NYC retirees and workers.

The key part of Section 12-126 that is in dispute is:

Section 12-126. … b. Payment of health insurance costs. Except as otherwise provided in section 12-126.1 and section 12-126.2 of this chapter, for city employees, city retirees and their dependents: * (1) The city will pay the entire cost of health insurance coverage for city employees, city retirees, and their dependents, not to exceed one hundred percent of the full cost of H.I.P.-H.M.O. on a category basis. Where such health insurance coverage is predicated on the insured's enrollment in the hospital and medical program for the aged and disabled under the Social Security Act, the city will pay the amount set forth in such act under 1839 (a) as added by title XVIII of the 1965 amendment to the Social Security Act. …

The City Council’s Legislative Authority

The City Council is the legislative body for the NYC government.

On June 28, 2001, the NYC City Council unanimously overrode the mayor’s veto and passed Local Law 39 of 2001.This law modified Section 12-126.b.(1) of the Admin Code of the city of New York. Specifically, it made permanent the full refund of Part B premiums to eligible NYC retirees who were paying those premiums to the federal government as part of their Medicare benefits. This vote makes it clear that the City Council has authority over this part of Section 12-126 even in the face of mayoral opposition. As an insight to this law, remember who the mayor was in 2001.

The Proposed MAP Contract

As part of the Medical Advantage Plus (MAP) contract that the City wants to sign with Alliance, there is the following clause (Addendum A, Quoted Stipulations, page 4 ):

“Retirees who opt out of the NYC Medicare Advantage Plus Plan must pay the premium difference between the NYC Medicare Advantage Plus Plan and their selected retiree Medicare health plan, if applicable.”
In its raw form, this an agreement between two parties to damage a third party. The City and Alliance drafted this provision to put in place a mandatory penalty for retirees who choose to leave the MAP plan. The driving force behind Alliance’s profit margin is the number of retirees in the MAP plan. The more retirees that opt out, the less money that comes in from CMS ,the federal Medicare administrator, and the higher the risk of claim losses becomes.

Attack on the City Council

In addition to this attack on retirees, the clause is a secretive attempt to subvert the legislative authority of the City Council. It is my opinion that this clause violates the City Charter. The clause clearly attempts to block the City Council’s legislative authority over Section 12-126 and destroy the purpose of this 54-year-old statute.

At the November 10th City Council contract hearing, the OLR Commissioner made no mention of this penalty clause in the contact. She was there to sell the benefits of the MAP plan and not clearly state the problems with the MAP plan. Specifically, there was no mention of the fact that this would be an almost $4B annual contract. That is the amount that CMS will pay Alliance each year to cover the retirees’ health benefits. According to the stipulations in the contract, the City will only pay a trivial $14M in the first year of this five-year contract ($7.50 per month per retiree). This a dump and run scam if I ever saw one.

What would happen if the City Council chose to begin action to modify Section 12-126.b.(1) explicitly requiring the City to pay for the Senior Care premiums for eligible NYC retirees, like the action it took with Local Law 39/2001?

Would the Law Department argue that the mayor’s contract prevents the Council from passing such a law? I am beginning to think that this contract is illegal as it is currently drafted.

Saturday, November 20, 2021

Stupidity and the Medicare Advantage Scam

I am assuming that all NYC retirees and workers know that the City is trying to screw with retirees Medicare benefits. Enough with abuse of power and illegal actions, let's look at the City's stupidity.

Cross Over Retirees

Consider a current 66 year old male NYC retiree with traditional Medicare and GHI Senior Care coverage. He has a 62 year old wife. With respect to Part D coverage at age 65, he continued his family drug coverage with GHI which he started when he retired at age 62. He pays the the family GHI-CBCBS drug premium ($149.96), not the Senior Care family drug premium ($300.60).

In FY-2021 the City paid $2,023.61 per month to GHI for CBP/EBCBS family health insurance. This was for workers and retirees with non-Medicare eligible dependents. This means that the City is paying GHI $2,023.61 for this retiree's family health insurance even though he is Medicare eligible. I am almost dead sure that the City is not paying GHI the $194.14 per month individual Senior Care premium for this retiree, since it is already forking over the $2,023 each month.

Now consider that in 2021 this retiree and his wife adopted two newly born children. The retiree now has three dependents on his health insurance coverage and the City now has a 25 year liability for family GHI CBP/EBCBS health insurance costs. As I stated above the monthly cost for the GHI family coverage is $2,023.61. That is $24,283 per year. Even when the retiree's wife turns 65, the City will still have to pay the $2,023 per month

The New MAP Plan for January 1, 2022 - With a Court Stay in Place

On January 1, 2022 the City wants to jam this retiree, along with all other Medicare eligible retirees (not HIP-HMO), into a Medicare Advantage plan with the express purpose of avoiding paying the Senior Care $194.14 per month premium. Of course, the City is not actually paying for this retiree. The City then wants to give the "savings" to the union welfare funds (the MLC).

In fact the City will probably never save any money on this retiree.

Political Blowback

Since the City can not escape paying the $2,023.61 per month for this retiree, would it not be more politically advantageous to leave this retiree in his current "Senior Care". You know this family is going to be radically motivated to rip the heart out of the scum that are screwing up their health insurance. Of course all effected retirees are going to want to get revenge but the City is not even getting any "savings" in this case.

I created this exaggerated case to highlight the complications of the Medicare Advantage scam. There about 158,000 Medicare eligible city retirees covered by Senior Care. I guarantee you that 25% of those retirees fall into this cross over scenario to some extent. Just think of a 66 year old retiree marrying a 55 year old. Happens all the time. All of a sudden the cost goes from zero to $24,283 per year.


The City has created a Catch-22 for the Medicare eligible retirees. The City will not be saving anything on these cross over retirees and yet the City is punishing them by reducing their benefits.

The retirees are either forced into the new inferior "free MAP" plan or pay the Senior Care $191 a month premium each for themselves and everyone of their Medicare eligible dependents plus $125 month each, for Part D coverage, for themselves and everyone of their Medicare eligible dependents.

Of course the new free MAP plan is not totally free since the drug coverage will cost $125 per month each for the retiree and any of his/her Medicare eligible dependents. In addition, the retiree can not choose to buy the Part D drug coverage on the open market since CMS gives Medicare Advantage plans a monopoly on Part D coverage. Interestingly, the retiree in Senior Care plan can shop for a better Part D drug plan.

How About a Little Intelligence

The City has pressure on it health insurance costs. Instead of picking on a party that the City thinks it can walk over, how about bringing all parties together. That means the insurance companies, the workers, and the retirees. Get the insurance companies to offer better coverage at lower cost and require all the workers and the retirees to make a monthly payment. That would also mean that the City would have to be totally transparent. That is a big problem. Don't feel sorry for the City. The federal government gave the City $1.02B in FY-2022 to pay for workers health insurance.

Tuesday, November 9, 2021

FY-2021 Was a Very Good Year for the City Pension Funds -- $57.5B Increase

Short and sweet, read pages numbered 218 and 219 from the NYC FY-2021 CAFR.

Pages 136 to 144 are interesting reading about the cost of non-pension benefits to retirees.

Saturday, November 6, 2021

A Simple Look at the Pro's and Con's of Medigap Insurance and Medicare Advantage Insurance From the Wall Street Journal

I have previously written about the City's Medicare Advantage scam. That is the one where the City saves money by taking away traditional Medicare/Medigap insurance from retirees over age 65 and dumping them into a Medicare Advantage plan. The City then gives the money saved to City unions for their patronage welfare funds.

It is really difficult sorting through the pros and cons of the Medicare/Medigap versus the Medicare Advantage plans. This is especially hard since the insurance companies, who run the Medicare Advantage plans, spend huge amounts of money promoting their extremely profitable businesses.

I recently, however, came across a very simple straight forward explanation in the Wall Street Journal, of all places. Please read the article.

The basic conclusion is that if you can afford it, the Medicare/Medigap program is the better choice, since soon or later we all have signification health issues. For decades the City, by statute, has been paying for the Medigap insurance for its retirees. Now it wants retirees to pay for the insurance and give the savings to the union welfare funds.